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Biomedical subjects

R Raz

Publications and source records attributed to R Raz.

At least 91 records · Page 5Linked to original sources
PubMed1995

Can an educational program improve the diagnosis and treatment of pharyngotonsillitis in the ambulatory care setting?

The influence of an educational program on the diagnosis and treatment of pharyngotonsillitis was evaluated in three outpatient clinics in northern Israel during two periods. During both periods--1 January to 31 March 1988 (baseline phase) and 1 January to 31 March 1989 (study phase)--clinical data of all patients for whom antibiotics were prescribed were recorded on special forms, which included the patient's diagnosis and the antibiotic prescribed. In November 1988, 2 months before the study phase, two 1 h sessions on pharyngitis were given by the study physicians to the entire medical staff of two clinics (Clinics B and C), and written material was distributed. A third clinic (Clinic A) served as the control. A comparison of the prescribing habits during the two phases showed that during the study phase the total number of antibiotics prescriptions for pharyngitis declined significantly in Clinics B and C, while the percentage of prescriptions for penicillin V rose with the concomitant decline of amoxycillin. There were no significant changes in prescribing habits in the control clinic. These results show that a modest 2 h educational program involving direct contact with the entire medical staff of the community outpatient clinics can improve the diagnosis of pharyngotonsillitis and reduce both the inappropriate use of antibiotics in general, and the substitution of more expensive antibiotics for cheaper, equally effective ones.

Adult↗
PubMed1995

Oral fluoroquinolone use in the community.

The use of oral fluoroquinolone in the community was evaluated in the Jezreel Valley area in northern Israel over an 8-month period. A total of 1,136 prescriptions for oral quinolones were prescribed for a population of 300,000 people. The findings of the study show that 70% of the prescriptions were initiated by outpatient clinic specialists or at hospital discharge, and that 70% of all prescriptions were justified and properly prescribed. No significant difference was found whether the initiating physician was a specialist or family practitioner or when the drug was recommended on hospital discharge. Moreover, the manner in which the different antibiotics were internally divided indicated the prescribing physicians' understanding of the properties of each drug. The results demonstrate that oral fluoroquinolones have been used in the Jezreel Valley area sparingly, judiciously, and according to each drug's properties. The high degree of justified use may reflect successful antibiotic control within the medical center serving that area.

Administration, Oral↗
PubMed1994

Acute phase response factor and additional members of the interferon-stimulated gene factor 3 family integrate diverse signals from cytokines, interferons, and growth factors.

Cytokines and growth factors elicit responses in target cells through induction of gene expression. Signaling mechanisms leading to gene transcription from cell surface receptors often require tyrosine phosphorylation. A family of transcription factors comprising the interferon (IFN)-stimulated gene factor 3 (ISGF3) multimeric complex are phosphorylated and activated in response to interferon. We describe a protein 50% identical to the 91-kDa subunit of ISGF3 that constitutes the acute phase response factor (APRF). This protein was rapidly activated by interleukin-6 to bind an enhancer element common to genes activated in liver cells during the acute phase response to inflammation. Remarkably, APRF was also activated by IFN alpha, IFN gamma, epidermal growth factor, platelet-derived growth factor, colony stimulating factor-1, and the cytokines leukemia inhibitory factor and oncostatin M. The growth factors also activated a third, distinct but related, DNA-binding protein in addition to APRF and p91. This novel factor or a closely related one, but neither APRF nor p91, was also activated in lymphoid cells by interleukin-2, erythropoietin, and interleukin-3. Activation of APRF, p91, and additional members of the ISGF3 family is thus a general feature of a wide variety of signaling pathways, integrating diverse signals through common transcriptional regulators.

Animals↗
PubMed1994

The incidence of urinary tract infection in patients without bacteriuria who underwent extracorporeal shock wave lithotripsy.

The incidence and severity of urinary tract infections in 145 patients with renal calculi undergoing extracorporeal shock wave lithotripsy (ESWL*) who were catheterized for a short period without evidence of bacteriuria and/or infected stones evaluated. The patients were followed clinically and bacteriologically 1 and 14 days after the procedure. Bacteriuria was observed in 7 of the 145 patients (4.8%): in 5 patients 24 hours after ESWL and in 2 patients 2 weeks later. Of these patients 2 were symptomatic but only 1 had fever. No patient was hospitalized. We found no correlation between bacteriuria and the number or size of the stones. We conclude that the incidence of bacteriuria in catheterized patients who underwent ESWL without urinary tract infection is low and the use of antibiotics in these patients is probably not indicated.

Adult↗
PubMed1994

Epidemiological and serological studies in HIV-infected Ethiopian immigrants to Israel.

In the last 10 years, Ethiopian Jews have immigrated to Israel in large numbers. Up to 1990 they came directly from their remote villages in northern Ethiopia and no HIV infection was detected in the several thousands that came. In contrast, 1.74% of approximately 14,000 new immigrant Ethiopians who arrived in 1991-92, after spending more than a year in Addis Ababa, were HIV positive. Several infants born in Israel following the latter immigration were found to be infected, whereas more than 2500 children born in Ethiopia were negative. Sexual transmission during their stay in Addis Ababa is thought to be the only route of infection, and therefore this is a newly infected population. Immunological studies revealed very low CD4 count in HIV-infected people. HIV-negative Ethiopian immigrants to Israel also have a lower CD4 count than the general Israeli population. Further studies are currently under way to look at the natural history of this particular HIV-infected group.

Adolescent↗
PubMed1994

Single-dose fosfomycin trometamol versus 5-day cephalexin regimen for treatment of uncomplicated lower urinary tract infections in women.

A randomized study was conducted to assess the clinical and microbiological efficacies of a single 3-g dose of fosfomycin trometamol for the treatment of uncomplicated lower urinary tract infections in women compared with a 5-day regimen of cephalexin at 0.5 g four times daily. One hundred twelve women, all of whom had documented infections with bacteria sensitive to both antibiotics, were included. Fifty-eight women received fosfomycin trometamol, and 54 women received cephalexin. The two groups did not differ in age, severity, or duration of current urinary tract infection, menstrual status, sexual activity, or use of contraceptives. Ninety percent of pathogens in the fosfomycin trometamol group and 81% in the cephalexin group were Escherichia coli (the difference is not significant [NS]). A clinical evaluation at the 5-day follow-up showed that 91% of the women in each group were free of symptoms, while five women in each group were considered therapy failures and were treated by another antibiotic course. A microbiological evaluation at the 5-day follow-up showed a 91% eradication rate in the fosfomycin trometamol group and an 83% eradication rate in the cephalexin group (NS). At the 1-month follow-up, a clinical evaluation demonstrated prolonged resolution in 86 and 78%, respectively, of the participating women (NS). A microbiological evaluation at 1 month demonstrated prolonged eradication in 47 (81%) women treated with fosfomycin trometamol and in 37 (68%) women treated with cephalexin (NS). Three and six women, respectively, had relapsed. No adverse reactions were reported by the fosfomycin trometamol-treated women, while three women treated with cephalexin reported mild adverse reactions but completed the study period. Fosfomycin trometamol in a single 3-g dose is as effective as a 5-day regimen of cephalexin for the treatment of uncomplicated lower urinary tract infection in women.

Adolescent↗
PubMed1994

Double-blind study comparing 3-day regimens of cefixime and ofloxacin in treatment of uncomplicated urinary tract infections in women.

This double-blind randomized study compared 3-day regimens of cefixime (400 mg once daily) and ofloxacin (200 mg twice a day) in the treatment of urinary tract infections in women. The respective clinical cure rates for the two groups of women were 89 and 92% after 7 days and 81 and 84% after 4 weeks. The respective microbiological cure rates (free of bacteriuria) for the two groups of women were 83 and 86% after 7 days and 77 and 80% after 28 days. A 3-day cefixime regimen seems to be as efficient as a 3-day ofloxacin regimen in the treatment of uncomplicated cystitis in women.

Adolescent↗
PubMed1993

A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections.

BACKGROUND: Recurrent urinary tract infections are a problem for many postmenopausal women. Estrogen replacement restores atrophic mucosa, lowers vaginal pH, and may prevent urinary tract infections. METHODS: We enrolled 93 postmenopausal women with a history of recurrent urinary tract infections in a randomized, double-blind, placebo-controlled trial of a topically applied intravaginal estriol cream. Midstream urine cultures were obtained at enrollment, monthly for eight months, and whenever urinary symptoms occurred. Vaginal cultures and pH measurements were obtained at entry and after one and eight months. The women were assigned to receive either estriol (n = 50) or placebo (n = 43), both administered intravaginally; 36 and 24, respectively, completed the eight months of follow-up. RESULTS: The incidence of urinary tract infection in the group given estriol was significantly reduced as compared with that in the group given placebo (0.5 vs. 5.9 episodes per patient-year, P < 0.001). Survival analysis showed that more of the women in the estriol group than in the placebo group remained free of urinary tract infection (P < 0.001). Lactobacilli were absent in all vaginal cultures before treatment and reappeared after one month in 22 of 36 estriol-treated women (61 percent) but in none of the 24 placebo recipients (P < 0.001). With estriol the mean vaginal pH declined from 5.5 to 3.8 (P < 0.001), whereas there was no significant change with placebo. The rate of vaginal colonization with Enterobacteriaceae fell from 67 percent to 31 percent in estriol recipients but was virtually unchanged (from 67 to 63 percent) in the placebo recipients (P < 0.005). Side effects were minor, but caused 10 estriol recipients (28 percent) and 4 placebo recipients (17 percent) to discontinue treatment. CONCLUSIONS: The intravaginal administration of estriol prevents recurrent urinary tract infection in postmenopausal women, probably by modifying the vaginal flora.

Administration, Intravaginal↗
PubMed1993

Structural abnormalities associated with congenital megacolon in transgenic mice that overexpress the Hoxa-4 gene.

Congenital megacolon develops in transgenic mice that overexpress the homeobox-containing gene, Hoxa-4. The current study was done to identify abnormalities of the terminal colon that might account for the phenotype. The terminal bowel of transgenic mice was compared with that of control and lethal spotted (ls/ls) mice, a strain in which megacolon also develops. The terminal colon of the transgenic mice contained fewer ganglia than that of controls, but was hypoganglionic, rather than aganglionic like that of ls/ls mice. The neurons present in the adult transgenic colon were significantly increased in size and a subset of very large neurons (> 40 microns in maximum diameter) were observed. Electron microscopic studies of young adult transgenic mice revealed that the ganglia and nerves of the myenteric plexus had the ultrastructure of extraenteric peripheral nerve rather than that of the enteric nervous system (ENS). The myenteric ganglia in the transgenic animals contained Schwann cells associated with a basal lamina that enveloped axons completely and individually, instead of glia. Although collagen is excluded from the ganglia and thin nerve fibers of the normal ENS, a collagen-containing endoneurium surrounded each of the axon-Schwann cell units of the abnormal nerve fibers of the transgenic colon. Some of the neurons of the transgenic mice were located in these nerve bundles rather than in ganglia. There were also smooth muscle abnormalities in the terminal bowel of the transgenic mice. Wide gaps were present in the longitudinal muscle of the transgenic mice; these gaps contained ganglia that were in contact with the adventitia. These longitudinal smooth muscle cells were more irregular than those of controls and they contained fewer puncta adherens; moreover, a larger proportion of the volume of the cytoplasm of transgenic smooth muscle cells was occupied by organelles. Finally, an extensive thickening and reduplication of the basal lamina surrounding the smooth muscle cells of the muscularis mucosa was observed in the transgenic colon and resembled that found in ls/ls mice. These data suggest that both smooth muscle and the innervation of the terminal bowel of neonatal Hoxa-4 transgenic mice are structurally abnormal. Although some of the abnormalities seen in Hoxa-4 transgenic mice are similar to those which arise in ls/ls mice, the two conditions are not identical. In both animals, the data are consistent with the hypothesis that the defects arise as a result of a defective interaction between the precursors of enteric neurons and smooth muscle.

Acetylcholinesterase↗
PubMed1993

Re-emergence of meningococcal carriage on three-year follow-up of a kibbutz population after whole-community chemoprophylaxis.

A long-term study was conducted to determine the rate of re-emergence of throat carriage of meningococci in a semi-closed kibbutz community after the administration of chemoprophylaxis to all its members. Serotype B:4 was selected as marker organism since it was isolated from a fatal case and was the most frequently occurring strain (80%) among serogroup B isolates, which themselves comprised 54% of all meningococci. The carriage rate among Israeli residents (volunteer workers were analyzed separately) before treatment was 6.6% (49/748) overall, with 4.3% group B strains. Three weeks after treatment, in most cases with rifampicin (whereby three persistently positive persons were retreated with minocycline), no meningococci were recovered. Six months later, 1.9% of a population sample aged < or = 30 years were positive, while before treatment and one and three years later, 9.4%, 8.6% and 4.6% respectively were positive in this age group. Serotype B:4 comprised 81.3% of group B strains before prophylaxis, 5.3% after one year, and 28.6% after three years, thus possibly re-establishing itself as the single dominant serotype. The marked suppression of carriage after mass chemoprophylaxis appeared to last at least six months, with the meningococcal population being re-established within a year.

Adolescent↗
PubMed1993

Typhoid fever in Ethiopian immigrants to Israel and native-born Israelis: a comparative study.

Typhoid fever remains a major cause of mortality in developing countries, with a case-fatality rate (CFR) of 12%-32%, whereas in developed countries this rate has successfully been reduced to < 2%. The cause of this high CFR in developing countries was investigated by studying two populations of patients who had typhoid fever during the years 1984-1985: Ethiopian Jews who were infected in Africa (a region with a high CFR) and treated in Israel (a region with a low CFR) and native-born Israelis. The causative organisms were of similar phage types. Among 121 Ethiopian Jews there were two fatalities (CFR, 1.65%), and among 204 native-born Israelis there were three fatalities (CFR, 1.47%). Findings of the clinical course and treatment were similar for 15 Ethiopian Jews and 14 native-born Israelis and consistent with those of reports from developed countries. We conclude that the high CFR for typhoid fever in Africa is due to delayed hospitalization and treatment rather than to differences in host factors or in the virulence of the pathogen and that mortality can be reduced by hastening hospitalization and treatment.

Adolescent↗
PubMed1993

Infections following nail puncture wound of the foot: case reports and review of the literature.

Between July 1989 and August 1990, five children (four boys and one girl, age 10-14 years) were hospitalized due to foot infection following nail puncture wound. Symptoms and signs at presentation included cellulitis and deep tissue abscess in all five, fever in three, high erythrocyte sedimentation rate in four, and leukocytosis in two patients. Pseudomonas aeruginosa was grown in pus culture that was taken from all the children at presentation. In three children who were initially treated by local debridement and drainage followed by anti-pseudomonal agents, plantar Pseudomonas osteochondritis later developed. In two children extensive debridement of affected tissues and drainage of pus were performed followed by 2 weeks of parenteral anti-Pseudomonas antibiotics. No further complication occurred. The clinician should be aware that any complication of nail puncture wound of the foot may require surgery.

Abscess↗
PubMed1993

Seroprevalence of antibodies against Toxoplasma gondii among two rural populations in northern Israel.

The prevalence of antibodies against Toxoplasma gondii was measured in two rural populations in northern Israel--Jewish kibbutz members and Arab villagers. The respective prevalences in these two populations were 22.2% and 55.8% (P < 0.001). No correlation was found between the presence of antibodies and sex, occupation, contact with cats, a history of fever and/or lymphadenopathy, eye disease, abortions or delivery of children with congenital malformations. In contrast to Jewish children who were not found to have antibodies in the first decade of life, 20.5% of Arab children tested positive. A gradual increase in the prevalence of antibodies with age was seen in both groups, with the Jews reaching a prevalence of 42.6% at age 60+ and the Arabs reaching 74% at age 40. The difference between the two groups probably stems from different eating habits, namely ingestion of raw meat and unpasteurized milk and milk products.

Adolescent↗